ABSTRACT
Objective To compare the preventive effect on bile duct thermal damage of percutaneous transhepatic cholangial drainage (PTCD) intubation with that of endoscopic nasobiliary drainage (ENBD)intubation,through which cooling liquid is continuously infused,in treating hepatocellular carcinoma (HCC)located close to the hepatic hilum by using percutaneous microwave ablation (PMWA) therapy.Methods The clinical data of 23 patients with HCC that was located close to the hepatic hilum,who were admitted to authors' hospital during the period from September 2013 to September 2016 to receive PMWA,were retrospectively analyzed.Among the 23 patients,PTCD intubation was employed in 12 and ENBD intubation was adopted in 11,and the cooling tube was placed in the bile duct near the tumor.Through the tube 4℃ cooling saline was rapidly and continuously infused,meanwhile PMWA was carried out under the guidance of B-ultrasound.The occurrence of thermal damage of the bile duct,the cooling technique-related complications,and the recurrence of HCC were compared between PTCD ~oup and ENBD group.Results The mean follow-up time was 20 months (3.0-36.0 months),and no operation-related death occurred in all 23 patients.In each group,postoperative biloma occurred in one patient.No obvious cooling techniquerelated complications were observed in PTCD group,but in ENBD group 4 patients (36.36％) developed cooling technique-related complications,including hemorrhage after incision of duodenal papilla (n=1,9.09％) and acute pancreatitis (n=3,27.27％);the difference in the incidence of cooling technique-related complications between the two groups was statistically significant (P=0.037).No statistically significant differences in local recurrence rate,intrahepatic recurrence rate and mortality existed between the two gro ups(P=1.00,P=0.77 and P=0.61,respectively).Conclusion For the treatment of HCC located close to the hepatic hilum with radical PMWA therapy,continuous infusion of cooling liquid through PTCD intubation or ENBD intubation to prevent the thermal damage of the bile duct is clinically feasible and effective,and PTCD intubation method has less technique-related complications than ENBD intubation method.
ABSTRACT
Objective To investigate the characteristics of hepatitis virus B ( HBV) reactivation af-ter combined percutaneous microwave ablation ( PMWA ) and transcatheter arterial chemoembolization ( TACE) in patients with hepatocellular carcinoma ( HCC) and to study the therapeutic role of preoperative antiviral therapy .Methods The data on 180 HCC patients who were treated with the combined therapy were analyzed .The antivirus group ( n=90 ) received antiviral therapy , while the control group ( n=90 ) did not.HBV-DNA was used to study the reactivation status of HBV after the combined therapy and the role of antiviral therapy .Results The incidence of HBV reactivation was significantly lower in the antivirus group (8.2%, 7/90) than the control group (20.0%, 18/90, P<0.05).A preoperative HBV-DNA level above 104 copies/ml was the only independent risk factor of HBV reactivation (P<0.05).Conclusions The HBV reactivation rate was relatively high in patients with HBV-related HCC after combined PMWA and TACE.Preoperative antiviral therapy significantly reduced HBV reactivation and thus it should be adminis -trated especially to HCC patients with a preoperative HBV-DNA level above 104 copies/ml.
ABSTRACT
Objective To investigate the effects of transarterial chemoembolization (TACE)treatment interval on the prognosis of patients with advanced hepatocellular caisinoma(HCC).Methods We retrospectively collected clinical data of 123 advanced HCC patients treated with repeated TACE.The patients were divided into two groups (group A with fixed repeated treatment interval and group B with that according to the clinical needs).Cox regression,survival curve and log-rank test were used to assess the effects of the treat-ment intervals on prognosis.Results The treatment intervals of the group A and group B were (1.1±0.3)months and (3.0±1.5) months,respectively (P <0.001).Multivariate Cox analysis showed the efficacy (P =0.024)and repetition periods (P <0.001 ) were independent prognostic factors.Conclusion TACE interval is independent risk factor for the prognosis of patients with ad-vanced HCC.Repeated TACE treatment according to clinical needs may be more favorable for prognosis of the patients.
ABSTRACT
Objective To investigate the safety and clinical effect of endovascular radiofrequency ablation (RFA) catheter, the HabibTM VesOpen, in treating portal vein tumor thrombus. Methods Fifteen patients of hepatocellular carcinoma associated with portal vein thrombus causing obstruction of blood flow were enrolled in this study. Guided by ultrasound percutaneous portal catheter implantation was performed, then, under DSA guidance RFA catheter was placed at portal vein tumor thrombus. RF generator (RITA) was connected to the electrodes, the power was set at 10 W for 2 - 10 minutes. The technical success rate, the postoperative complications, the hepatic and renal functions as well as routine blood tests, portal vein blood flow and the ablation extent of portal vein tumor thrombus were evaluated, and the results were analyzed. Results The procedure was successfully accomplished in all patients. No technique-related complications, such as hemorrhage, vessel perforation, bile leak complicated by infection, liver abscess, abdominal bleeding occurred. Direct portography performed immediately after RFA showed that the portal vein was re-opened. Laboratory examinations performed 4 weeks after RFA showed that no obvious changes in hepatic functions and routine blood tests were observed. Doppler ultrasound examinations revealed that flowing blood was obviously displayed within previously obstructed portal vein. CT scanning was carried out in some patients with portal vein thrombus, and it indicated that the portal vein tumor thrombus was reduced in size or even disappeared. Conclusion For the treatment of portal vein tumor thrombus in patients with hepatocellular carcinoma, endovascular radiofrequency ablation is technically feasible, and the initial results indicate that this technique is an effective treatment.
ABSTRACT
Objective To evaluate CT findings, diagnosis and management of intrahepatic biliary injuries after transcatheter arterial chemoembolization (TACE) for liver malignancies. Methods A total of 1302 patients with hepatic malignant tumors received TACE between Sep 2007 and Mar 2009. None of these patients were found to have any radiographic evidence of biliary abnormalities before TACE. A retrospective review of imaging studies and clinical outcomes was carried out to evaluate the changes of intrahepatic biliary injuries after TACE. Results Six patients developed intrahepatic biliary injuries during 1 and 3-month follow-up. Two cases with jaundice and high fever, underwent percutaneous transhepatic cholangiography and drainage and eventually recovered. The other 4 patients were asymptomatic with only radiographic changes and were managed observationally. Conclusions Intrahepatic biliary injury is a rare complicating TACE procedures. It will be identified by clinical outcomes and radiographic imaging findings. Percutaneous transhepatic cholangiography and drainage (PTCD) is the therapy of choice for intrahepatic biliary injuries with jaundice or high fever.
ABSTRACT
Objective:To observe the level of endogenous cortisol in patients with advanced gastrointestinal cancer, and to evaluate the effect of exogenous glucocorticoids treatment on patient's malignant symptoms and serum cortisol level. Methods:Thirty-one patients with advanced gastrointestinal cancer who were given 40 mg/d methylprednisolone for continuous 5 days. The patients included 8 patients with esophageal and cardial cancer, 12 patients with gastric cancer, and 11 patients with colorectal cancer. At the same time, 30 healthy adults were selected as control group. The cortisol radioactive immunoassay kit was used to determine the level of serum cortisol in the gastrointestinal cancer patients and controls. The life quality changes of gastrointestinal cancer patients were evaluated. Results:The serum cortisol level of 31 advanced gastrointestinal cancer patients was higher than that of healthy volunteers [(312.39±57.64)vs(144.64±52.20) μg/L,P0.05). Conclusion:Endogenous serum cortisol levels of gastrointestinal cancer patients were significantly higher than those of healthy adults. Short-term treatment with medium dosage of exogenous glucocorticoids had little effect on the endogenous serum cortisol level.